Autoimmune Disorders In Chronic Liver Disease And Their Importance In Hepatitis C Virus Infection
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Non-organ specific and or liver-specific autoimmune antibodies have been f I in several chronic liver diseases that are not primarily autoimmune in nature. To investigate autoimmune disorders in patients with chronic liver disease, we studied 40 chronic HCV patients defined by elevation of serum ALT for at least 6 months, positive IICV Al) by third generation ELISA and /or positive IICV-RNA and negative IlBs Ag, in addition to 20 chronic IIBV patients defined by elevation of ALT for more than 6 months, positive HBsAg and negative IICV markers, in comparison to 20 normal healthy control and 20 Alll controls with definite All (12 with All-1 and 8 with AIII-2). Fifty six (56%) and 50% of chronic IICV and chronic IIBV patients, respectively, had associated chronic schistosomiasis (defined by positive stool specimens for eggs or positive rectal snip biopsy) while 37.5% of chronic IICV group had liver cirrhosis (defined by liver biopsy). All subjects were screened for ANA, ASMA, ALKM-I and AMA using indirect immunoflourescenc technique. We found high prevalence of positivity for autoimmune markers in patients with chronic IICV; ANA (55%), ASMA (47.5%), ALKM-I (30%) and AMA (2.5%) compared to 15%, 10%, 0% and 0% in chronic IIBV patients, respectively, where the difference was significant (P<0.05). Unlike AIII, the prevalence of autoimmune markers in patients with chronic IICV was not sex-related and autoantibodies are less frequently detected at high dilutions. There were no significant differences in age, sex, severity of hepatitis, association of chronic schistosomiasis or response to INF-a therapy between chronic IICV patients who were positive for autoimmune markers and those who were not. None of the patients treated with INFo: developed clinical manifestations of autoimmune disease. The study showed that autoimmune markers are highly prevalent in Egyptian chronic HCV than in chronic HBV patients and that HCV infection enhances the initiation and perpetuation of autoimmunity. The presence of such antibodies should not preclude therapy with IN Fa, which often improves hepatitis and features of autoimmune disease in patients with both.